Total Hip Replacement

A total hip replacement is a surgical procedure wherein the damaged bone and cartilage of the hip is removed and replaced with an artificial implant or prosthetic components. It is also known as total hip arthroplasty. This procedure is performed to relieve pain and disability most commonly for patients with osteoarthritis, and for damage from other conditions such as rheumatoid arthritis, necrosis and trauma or injury.

Know More About Surgery

A hip replacement surgery may be considered for those patients who hip joint has been severely damaged. This can either be due to conditions like arthritis, sever injury or trauma, or any other disease that may cause damage to the hip joint. The following symptoms may present a need for a hip replacement surgery:-

  • Intense chronic pain
  • Stiffness in the hip
  • Pain that limits everyday activities like walking or bending
  • Inability to move or lift the leg
  •  Severe pain that does not go away even after the use of anti-inflammatory drugs or therapy
  • Fracture of the hip joint
  • Aseptic or Avascular necrosis

The following tests and diagnostic methods are used in order to diagnose problems with the hip bone:

  • Medical history- the orthopaedic surgeon would ask questions about the patient’s general health, family history, severity and extent of pain, the extent to which the condition inhibits physical activity etc.
  • Physical exam- the doctor would conduct a physical exam to check for hip alignment, strength or stiffness. Hip mobility and range of motion will also be checked.
  • X-rays- X-rays would help in determining the extent of damage or deformity by looking for structural changes, signs of joint erosion, cartilage loss or tissue tear, inflammation etc.
  • Other tests- other tests such as a magnetic resonance imaging (MRI) scan may also be needed to determine the condition of the bone and soft tissue of the hip.

A 10-12 inch incision is made, usually at the side or back of the hip to expose the hip bone. The surgeon dislocates the joint and removes the femur from the socket (acetabelam) in the pelvis. The damaged femoral head is cut off and the acetabelam is reshaped. The acetabular cup prosthesis is placed into the reshaped socket. Next, the surgeon puts a rounded acetabular insert inside the cup to facilitate smooth movement of the joint. The femur bone is inserted with a prosthetic femoral stem which is a narrow, tapered metal shaft that fits several inches into the bone. The top of the femoral stem is then attached with a prosthetic ball that replaces the femoral head. The doctor checks for ease of motion and dislocation and X-rays are taken to make sure that the components are properly sized and positioned. The incision is then closed with the help of stitches or staples.

Total hip replacement is a major operation and there are certain risks associated with the same.

  • Infection at the wound site or deep into the prosthetics
  • Dislocation of hip replacement
  • Leg length inequality
  • Loosening of the prosthesis and implant wear
  • Fracture during or post surgery
  • Blood clots
  • Bleeding
  • Injury to the nearby blood vessels or nerves

The surgery is usually 2-4 hours long. The patient is then taken to a recovery room and observed for hours. The patient should notify the doctor immediately if numbness or a tingling sensation is felt. The patient is them transferred to a hospital room and is discharged in 3-5 days. Minor physical therapy is usually started on the first day itself, gradually moving on to activities like walking and climbing. Physical therapy and medications are continued once the patient is home as well. 

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Total Hip Replacement

A total hip replacement is a surgical procedure wherein the damaged bone and cartilage of the hip is removed and replaced with an artificial implant or prosthetic components. It is also known as total hip arthroplasty. This procedure is performed to relieve pain and disability most commonly for patients with osteoarthritis, and for damage from other conditions such as rheumatoid arthritis, necrosis and trauma or injury.

Symptoms

A hip replacement surgery may be considered for those patients who hip joint has been severely damaged. This can either be due to conditions like arthritis, sever injury or trauma, or any other disease that may cause damage to the hip joint. The following symptoms may present a need for a hip replacement surgery:-

  • Intense chronic pain
  • Stiffness in the hip
  • Pain that limits everyday activities like walking or bending
  • Inability to move or lift the leg
  •  Severe pain that does not go away even after the use of anti-inflammatory drugs or therapy
  • Fracture of the hip joint
  • Aseptic or Avascular necrosis

Diagnosis

The following tests and diagnostic methods are used in order to diagnose problems with the hip bone:

  • Medical history- the orthopaedic surgeon would ask questions about the patient’s general health, family history, severity and extent of pain, the extent to which the condition inhibits physical activity etc.
  • Physical exam- the doctor would conduct a physical exam to check for hip alignment, strength or stiffness. Hip mobility and range of motion will also be checked.
  • X-rays- X-rays would help in determining the extent of damage or deformity by looking for structural changes, signs of joint erosion, cartilage loss or tissue tear, inflammation etc.
  • Other tests- other tests such as a magnetic resonance imaging (MRI) scan may also be needed to determine the condition of the bone and soft tissue of the hip.

Treatment

A 10-12 inch incision is made, usually at the side or back of the hip to expose the hip bone. The surgeon dislocates the joint and removes the femur from the socket (acetabelam) in the pelvis. The damaged femoral head is cut off and the acetabelam is reshaped. The acetabular cup prosthesis is placed into the reshaped socket. Next, the surgeon puts a rounded acetabular insert inside the cup to facilitate smooth movement of the joint. The femur bone is inserted with a prosthetic femoral stem which is a narrow, tapered metal shaft that fits several inches into the bone. The top of the femoral stem is then attached with a prosthetic ball that replaces the femoral head. The doctor checks for ease of motion and dislocation and X-rays are taken to make sure that the components are properly sized and positioned. The incision is then closed with the help of stitches or staples.

Risks

Total hip replacement is a major operation and there are certain risks associated with the same.

  • Infection at the wound site or deep into the prosthetics
  • Dislocation of hip replacement
  • Leg length inequality
  • Loosening of the prosthesis and implant wear
  • Fracture during or post surgery
  • Blood clots
  • Bleeding
  • Injury to the nearby blood vessels or nerves

After Procedure

The surgery is usually 2-4 hours long. The patient is then taken to a recovery room and observed for hours. The patient should notify the doctor immediately if numbness or a tingling sensation is felt. The patient is them transferred to a hospital room and is discharged in 3-5 days. Minor physical therapy is usually started on the first day itself, gradually moving on to activities like walking and climbing. Physical therapy and medications are continued once the patient is home as well. 

FAQ Section

1) What is Total Hip Replacement Surgery?

Total Hip Replacement is a surgical procedure which aims to palliate a hip joint causing extreme pain with an artificial prosthetic made from metal and plastic components in order to restore its functioning.Total Hip Replacement is a surgical procedure which aims to palliate a hip joint causing extreme pain with an artificial prosthetic made from metal and plastic components in order to restore its functioning.

This procedure, also known as total hip arthroplasty, basically involves the replacement of the worn out cartilage and bone of the hip joint with a metal stem that is placed in the hollow center of the femur. It is usually performed when all the conventional methods haven’t helped or are no longer effective

2) Why does one need to perform Total Hip Replacement Surgery?

Arthritis damage is the main causative factor requiring a hip replacement surgery. Some of the common types of arthritis requiring a hip replacement surgery are :

1. Osteoarthritis – The breakdown of joint cartilage and adjacent bones of the hip.

2. Rheumatoid Arthritis – Inflammation of the synovial lining of the joint.

3.Osteonecrosis – Damage of the hip cartilage.

 

3) What are the risk factors of Total Hip Replacement?

Some of the commonly observed complications of a Total Hip Replacement Surgery include bleeding

  • infections
  • blood clots in the legs or lungs which is the most common risk factor.
  • Dislocation
  • need for revision or additional hip surgery
  • nerve injury causing weakness or numbness
  • unequal length of legs after the surgery
  • the replaced parts may become loose, break, or become infected.

4) How effective is Total Hip Replacement Surgery?

According to recent studies, the success rate of this surgery is extremely high causing a huge number of the population with arthritis opting for this surgery. It has been proved that more than 95% of the patients were relieved from hip pain. The success rate of hip replacements 10 years after surgery is 90- 95% and at 20 years, it is  80-85%.

5) When is the right time to undergo Total Hip Replacement?

Hip Replacement Surgery, being a major one, is advised to be performed when the pain starts to interfere and inhibit the day to day activities of an individual like sitting, walking etc. as it is associated with quite a number of risks. Some of the decisive factors are as follows :

The intensity of hip pain is so severe that it keeps you up at night.

  • The pain limits your ability to get up from a chair, climb stairs, or get into a car.
  • The pain makes obstructs the ease in performing simple activities such as walking, shopping, or swimming.
  •  Every other alternative pain relieving techniques have proved to be ineffective.

However, an orthopedic surgeon is best suited and qualified to determine if surgery is necessary.

6) Can I avoid Total Hip Replacement Surgery?

Some precautionary and effective strategies that are easily accessible like losing weight, strengthening muscles through the means of exercise or increasing flexibility through traditional physical activities can put off the surgery for a while. However, the intensity of damage is a crucial determining factor for the surgery based on the doctor’s analysis.

7) What are pre-diagnostic measures in Total Hip Replacement?

Some of the pre-diagnostic measures followed before the surgery are :

  • A thorough background check of the patient’s health record history is carried out.
  •  A physical test is done to check if the patient is suitable for the surgery which includes blood tests and other diagnostic tests like X-Ray and possibly an MRI.
  • It is highly crucial for the patient to inform the doctor regarding any allergies or infections to substances like latex, tape, and anaesthesia.
  • It is also important to inform your doctor regarding any bleeding disorders, pregnancy etc.
  • Based on your disorder, relative tests will be performed at the request of the doctor.

8) How is Total Hip Replacement Surgery Performed?

As the surgery undergoes, the surgeon will make an incision on the front side of the hip, removes the damaged, worn out bone and cartilage excluding the healthy bone and keeping it intact. He then implants the prosthetic socket into your pelvic bone, to replace the damaged one, and finally replaces the round ball on the top of the femur with the prosthetic ball, which is attached to the stem that fits into the thighbone.

9) How long will Total Hip Replacement take?

Generally, the Hip Replacement Surgery procedure lasts for about two hours; the operation time may vary from one to two hours.

10) What components are used in Total Hip Replacement?

In a Hip Replacement Surgery, the damaged parts of the hip joints are replaced by implants. These implants generally comprise of plastic or metal alloys  made of stainless steel, titanium, chromium, cobalt or a combination of the above.

Acrylic cement is used to settle the implant in its place. The type of implant to be used is usually recommended by the doctor based on various parameters like age, disease, the intensity of damage etc.

 

11) Will I experience pain?

Stiffness and soreness are experienced three months before it gradually subsides.

12) What is the duration of recovery?

After the surgery, once the patient has recovered and is stable, they will be required to stay in the hospital for a few days. A physical therapist will frequently visit the patient and follow an exercise rehabilitation schedule to enable a speedy recovery. Simple exercises are recommended to be practised after discharge. Follow-up appointments are scheduled with the doctor after 6-12 weeks and further recovery is expected within a time span of six to twelve months.

13) What activities can be performed after Total Knee Replacement Surgery?

Daily simple activities like walking, sitting etc can be performed a few days following the surgery. Low impact sports like golf, swimming, bowling etc are suggested plays an active role towards a normal and speedy recovery.

14) What is the cost of Knee Replacement surgery in India?

The cost varies from around fifty thousand rupees to five lakh rupees based on the hospital and the implants used. It also depends on whether its a total replacement or a partial replacement surgery.

15) Do people come from abroad for hip replacement surgery to India?

Yes, quite a number of people come to India for hip replacement surgeries due to eminent doctors, cheaper options, hospitals equipped with the latest technologies, lucrative insurance policies available at a nominal rate.

16) How do I choose the best doctor and hospital for a total hip replacement surgery?

This decision is dependent on several factors like budget, the comfort level of patient and most importantly the doctors performing the surgery. The orthopedic surgeon must be well experienced and knowledgeable as any negligence during the procedure can lead to grave consequences.